LEOPOLD’S MANEUVER
Purpose:
Systematically observing and palpating the abdomen to determine fetal presentation and position
PROCEDURE
1. Prepare the client
 Explain the procedure
 Instruct the client to empty her bladder
 Position the woman supine with knees slightly flexed.
Place a small pillow or rolled towel under one side
 Wash your hands using warm water
 Observe the woman’s abdomen for longest diameter
and where fetal movement is apparent
2. Perform the first maneuver
 Stand at the foot of the client, facing her, and place
both hands flat on her abdomen
 Palpate the superior surface of the fundus. Determine
consistency, shape, and mobility
3. Perform the second maneuver
 Face the client and place the palms of each hand on
either side of the abdomen
 Palpate the sides of the uterus. Hold the left hand
stationary on the left side of the uterus while the right
hand palpates the opposite side of the uterus from top
to bottom. Then hold the right hand steady, and
repeat palpation using the left hand on the left side
4. Perform the third maneuver
 Gently grasp the lower portion of the abdomen just
above the symphysis pubis between the thumb and
index finger and try to press the thumb and finger
together. Determine any movement and whether the
part is firm or soft
5. Perform the fourth maneuver
 Place fingers on both sides of the uterus approximately
2 inches above the inguinal ligaments, pressing
downward and inward in the direction of the birth
canal. Allow fingers to be carried downward
Reference:
Carmi B Portajada RNRM
PRINCIPLE
 Explanation reduces anxiety and enhances cooperation
 Doing so promotes comfort and allows for more productive
palpation because fetal contour will not be obscured by a distended
bladder
 Flexing the knees relaxes the abdominal muscles. Using a pillow or
towel tilts the uterus off the vena cava, thus preventing supine
hypotension syndrome
 Handwashing prevents the spread of possible infection. Using
warm water aids in client comfort and prevents tightening of
abdominal muscles
 The longest diameter (axis) is the length of the fetus. The location
of activity most likely reflects the position of the feet
This maneuver determines whether fetal head or breech is in the fundus
 Proper positioning of hands ensures accurate findings
 When palpating, a head feels more firm than a breech. A head is
round and hard; the breech is less well-defined. A head moves
indefinitely of the body; the breech moves only in conjunction with
the body
This maneuver locates the back of the fetus
 Proper positioning of hands ensure accurate findings
 This method is most successful to determine the direction the fetal
back is facing. One hand will feel smooth, hard, resistant surface
(the back), while on the opposite side, a number of angular
nodulations (the knees and elbows of the fetus) will be left.
This maneuver determines the part of the fetus at the inlet and its
mobility
 If the presenting part moves upward so an examiner’s hands can be
pressed together, the presenting part is not engaged (not firmly
settled into the pelvis). If the part is firm, it is the head; if soft, then
it is the breech
This maneuver determines fetal attitude and degree of fetal extension
into the pelvis; it should be done only if the fetus is in cephalic
presentation. Information about the infant’s anteroposterior position
may also be gained from this final maneuver
 The fingers of one hand will slide along the uterine contour and
meet no obstruction, indicating the back of the fetal neck. The
other hand will meet a obstruction an inch or so above the
ligament—this is the fetal brow. The position of the fetal brow
should correspond to the side of the uterus that contained the
elbows and knees of the fetus. If the fetus is in poor attitude, the
examining fingers will meet an obstruction on the same side as the
fetal back. That is, the fingers will touch the hyperextended head.
If the brow is very easily palpated (as if it lies just under the skin),
the fetus is probably in a posterior position (the occiput is pointing
toward the woman’s back).
Pillitteri A. (2007). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. 5th Edition. Lippincott Williams and Wilkins, USA.

Carmi B Portajada RNRM